Nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is an hepatic disorder with histologic features of alcohol-induced liver disease that occurs in individuals who do not consume significant alcohol. NASH is believed to be one of the most co mmon explanations for abnormal liver chemistries in American adults. Risk f actors for NASH include obesity, type II diabetes, hyperlipidemia, total pa renteral nutrition, jejuno-ileal bypass surgery, and the use of certain dru gs. However some patients with NASH have I za identifiable risk factors for the disease. Clinically NASH is a diagnosis of exclusion that should be su spected as a cause of chronic hepatitis in patients who deny significant al cohol consumption and have negative serologic tests for congenital and othe r aquired causes of liver disease. The identification of fatty liver on ima ging studies supports the diagnosis of NASH, which can be established defin itively by liver biopsy The latter also provides useful prognostic informat ion since most patients with simple steatosis follow an indolent clinical c ourse, whereas those with steatohepatitis, fibrosis, or cirrhosis are more likely to develop clinically significant complications of liver disease. We ight reduction and treatment of confounding medical conditions are the main stays of therapy for NASH. However; there is little evidence that any of th e current treatments prevent progression to more histologically advanced st ages of NASH. Several experimental therapies, including treatment with bile acids, antibiotics nutritional supplements, and antioxidants, have had ane cdotal success in selected patients, bur improved understanding of the path ogenesis and natural history of NASH will be required to develop generally effective therapy for the disorder.